Praying you can help me!

[cabingrl]

That's funny you say that because that's exactly what James said, that E-max wouldn't do well to support those wings. He recommended zirconium. I would really like to recommend that to the tech but I just want to tread lightly so I don't come across as telling him how to do his job. I don't like when patients try to tell me how to clean their teeth! "Don't poke me so hard with the pokey thing!" You guys are lucky you don't have a person attached to the teeth you work on. I'm kidding, I love my patients and I try to work with them as best I can.

As far as photos go...the ones we took here in the office make the teeth look fine because the bright light whites out the inner gray appearance. I took some photos in my bathroom mirror trying to capture that blue look but I can't figure out how to upload them here? Tried clicking on insert image but it asks for a URL...won't let me paste in the pic.

 

[martintay]

The first mistake is to prep the linguals as if they were to receive metal wings.
You need to redesign the prep to incorporate the cingulum and axial walls which will create connectors that transition into the lingual.

If you are replacing a pfm maryland then a pfz is a better option because of the existing preparation.

Thanks, How do you treat the Zr so that it can be etched ?

 

[cabingrl]

well there's my mistake...I married a CPA...not a lab tech! I can email the photo if anyone is interested you can give me your email address.

 

[2thm8kr]

"Why not bone augmentation for implants?"

the last thing you will need is bone augmentation, you will have stacks of bone as there were never any teeth there to start with.


That's a bold statement without radioraphs or Ct scans.

 

[paulg100]

CM laterals are not lost teeth so theres no socket for the bone to resorb into.

but OK, ill correct my post to say "highly unlikely"

"How do you treat the Zr so that it can be etched ?"

I leave extra space in the middle of the wing with a small border around the edge for the fit/seal. I then fire low fusing into it at the end. The wings can be etched then. it does mean you will have slightly thicker wings though.

 

[2thm8kr]

CM laterals are not lost teeth so theres no socket for the bone to resorb into.

but OK, ill correct my post to say "highly unlikely"

The OP said the implant surgery was aborted due to lack of bone for placement.

 

[paulg100]

oh well serves me for not reading properly!

 

[cabingrl]

Yes, I've had two docs tell me that I would need grafting to buildup enough bone for implants.

I have to say even though I've been up nights thinking about these teeth it's been fun and interesting hearing from all of you today. I just cleaned a woman's teeth who had FCs on 8 and 9 that were the hideous "vanilla pudding" colored ones done in the 70's. Could be worse, right?

I'm learning so much. I asked the assistant who worked on my case why Emax was used instead of zirconium and she said it's more asthetic looking. Hmmm...

Here are the things I'd like to bring up on Friday with the tech I meet with.

#1) Color/Shade concerns: can he remake them to appear less blue/gray on the "inside"... the outside enamel color looks just fine. Could he possibly do the "framework" from a BL shade to eliminate the internal darkness?

#2) Shape concerns: Can he "build up" that marginal 1/3 to be thicker so that it doesn't look so sunken back? I'd like it to appear very full and wide at the top. Silly request perhaps but I like the way the temps looked and they were built like that. I also requested a slight step up so that the laterals were shorter than the surrounding teeth. Kind of like Jessica Simpson's teeth. #7 pontic on this "grey" bridge tips back so far that it flares out and actually digs into my gingiva and I can't work floss underneath without drawing blood.

#3) The material that it is made of: My very very first set of marylands I ever had made had metal wings, so I have preps back there for metal wings. They were able to keep my next bridge after that on for over 10 years, it had non metal wings...don't know what they were...but had no problems. They were nice and thick, felt very sturdy! These emax wings feel very very thin, and one has already popped off exposing a sensitive lingual prep that I am trying to keep clean!

So those are the topics I'd like to cover with my tech. Hope he's as receptive and experienced as all of you. I also have a feeling I'm going ot be paying out of pocket entirely for this next set as I ok'd the appearance of the current ones. Learned my lesson. I hope I don't come across as petty or demanding. My teeth are just very important to me. I could care less about wrinkles and cellulite...I just want nice teeth! Ha ha. Thanks again for everyones input. You are all so gifted, I feel like I'm hanging out with the cool kids on the playground.

 

[MasterCeramist]

Something else to consider Is that not all labs or techs can produce or are willing to take the time to produce really esthetic anterior work. So don't settle for anything you are not happy with.

 

[cabingrl]

Thank you. The woman on the phone (secretary, not tech) was more than gracious. I don't even think they know I'm the hygienist for the practice they are working with and she was still very attentive with my needs and concerns over the phone. I hope they don't think I am expecting the red carpet rolled out, but I am just hoping the tech will be receptive to my requests.

Last time these emax bridges were seated with rely-x and I had a really quick fail on a distal wing. The doc did not etch the tooth, simply dried it off, then they squirted the rely-x on the wings and the prep, stuck it in and cured it with a light. Is that correct? She doesn't do many MBs so seeing as she is my boss I feel I can talk to her a little more candidly about how to do things!

 

[kcdt]

I opt for maryland bridges because when they tried to do posts for implants they had to abort because my bone was so thin and would not support the post.

This is actually typical for congenitally missing laterals. It is one of the few situations where implants are NOT a simple option. Given that, don't let anyone give you guff about a maryland bridge being second rate- it the least invasive fixed solution to the problem.

 

[kcdt]

Why not bone augmentation for implants? You could the eliminate Maryland bridges all together.
How about a diagnostic wax up to make sure the form and function are what you need?

It's a good idea, but it doubles the costs of the procedure, and I don't know many hygenists with 4 grand to toss around. Just sayin'

 

[TheLabGuy]

If they are E.max they should be bonded in, not cemented. There is a lot of research out there with bonded versus cemented e.max and bonded increases the longevity.

As for another poster that asked about zirconia, it's probably what I would do, especially if the original e.max fx. A slight glaze medium on the intaglio surface of the wings will allow you to etch the zirconium.

 

[SiKBOY]

I have an double winged emax Maryland bonded into mouth for years. No problems at all with it. If its bonded, that thing isn't going to come off. It sticks like sh1t to a blanket.

 

[USGooner]

Frank spear recommends only one wing vs two. Ie cantilever the Pontic off of the central or cuspid not both. Inevitably one wing will debond because the teeth flex in different directions. We've done Maryland bridges for years and have found that this is true after that one wing pops there doesn't seem to be issues. So we've been doing all our Maryland bridges with just one wing with no problems.

Also I would go with zirconia also as straight emax isn't strong enough. Good luck.

 

[Labwa]

e.max bonded will be fine as long as the connectors are thick. it sound like they may have used HT e.max which on a pontic looks grey. But good luck talking to the tech about HT and LT e.max they will no doubt get very deffensive of their decision. Im not sure about double winged? what about tooth movement with chewing/lateral forces? I see more problems in terms of one of the wings debonding adn leaving the other to do the job? I would stick with one if i was was prepping. Im glad im not!

 

[SiKBOY]

e.max bonded will be fine as long as the connectors are thick. it sound like they may have used HT e.max which on a pontic looks grey. But good luck talking to the tech about HT and LT e.max they will no doubt get very deffensive of their decision. Im not sure about double winged? what about tooth movement with chewing/lateral forces? I see more problems in terms of one of the wings debonding adn leaving the other to do the job? I would stick with one if i was was prepping. Im glad im not!

I had a zirc single wing Maryland and it failed. It popped off.

My thoughts are, the 2 wings have double the surface area so debonding chances are less. Also the biting forces are spread out across 3 teeth instead of 1 tooth that is taking double the load that it is supposed to.

Also, if one of the wings debonds, then it's the same as just having 1 wing. Just cut off the debonded wing when it does detach. I see double wings as extra insurance.

 

[2thm8kr]

It's a good idea, but it doubles the costs of the procedure, and I don't know many hygenists with 4 grand to toss around. Just sayin'

It seems this hygentist did have the dough, or it was done as a professional courtesy by the surgeon.
The original post stated that she was in for implant surgery, but aborted due to lack of supporting bone.

 

[cabingrl]

It seems this hygentist did have the dough, or it was done as a professional courtesy by the surgeon.
The original post stated that she was in for implant surgery, but aborted due to lack of supporting bone.

The implants were attempted when I was still in high school, my parents were in charge of the decisions with my teeth. I was just along for the ride. My orthodonist (back at the beginning of this whole journey) actually wanted to keep my canines next to the centrals and grind them down flat. Luckily my mom also works in the dental field and she said no way, make space for pontics! So she fought for me to have a full set and for that I am grateful. I am 31 now and woud still prefer MBs vs implants or even two 3-units. I like my natural centrals and canines and MBs have served me well to this point in my life. Do I expect them to last until my two and a half year old daugthers wedding? Not realistically. Maybe I'll think bone grafts down the road.

I was tossing and turning alot last night thinking of how I can approach this tech tomorrow and not make him defensive. The last thing I want to do is start throwing around a bunch of terms like "ingot" and "zirconia" and make him think I am trying to do his job. My plan is to always phrase things as a question;

First I was going to tell him thank you for even attempting these again, probably the only thing worse than making MBs for CM laterals is making MBs for a hygienist!

Then I was going to compliment the things I like about these current bridges...the opaque-ness at the incisal edge is beautiful and the slight step is just what I wanted. In most lights, the (forgive my ignorance to your trade) "outside color" of the pontic looks awesome..a perfect match! Love those parts.

My only concerns are the "inside color" looking grey. When he remakes them would it be possible to use a different material that looks whiter? (WHAT NOT TO SAY: "Hey I made a bunch of tech buddies online and they said you should have used an LT ingot!"). That's the big question that I'm trying to figure out how to phrase without pushing his buttons! I don't mind describing how I'd like the gingival margins thicker...and I certainly don't mind asking questions about why the wing already popped after a week or so. I am already prepped for two wings, so I'm sure they'll make them with two.

As techs who do this every day, would any of these statements/questions offend you? PLEASE BE HONEST! I would like feedback on how best to communicate my concerns and wants without offending him. How would you want to be spoken to in a situation like this? We have 24 laying hens and I even considered bringing the guy some farm fresh eggs as a bribe! Heck, maybe even bagels for his whole office! The other hygienist I work with said "Just wear something low cut and the guy will do whatever you want!" Ha! She's terrible.

As far as cementing vs bonding...Is rely-x a bonder? They used a curing light for maybe two seconds with whatever they put on. They did NOT etch, I know that, I used to work in ortho.

 

[2thm8kr]

The implants were attempted when I was still in high school, my parents were in charge of the decisions with my teeth. I was just along for the ride. My orthodonist (back at the beginning of this whole journey) actually wanted to keep my canines next to the centrals and grind them down flat. Luckily my mom also works in the dental field and she said no way, make space for pontics! So she fought for me to have a full set and for that I am grateful. I am 31 now and woud still prefer MBs vs implants or even two 3-units. I like my natural centrals and canines and MBs have served me well to this point in my life. Do I expect them to last until my two and a half year old daugthers wedding? Not realistically. Maybe I'll think bone grafts down the road.

I was tossing and turning alot last night thinking of how I can approach this tech tomorrow and not make him defensive. The last thing I want to do is start throwing around a bunch of terms like "ingot" and "zirconia" and make him think I am trying to do his job. My plan is to always phrase things as a question;

First I was going to tell him thank you for even attempting these again, probably the only thing worse than making MBs for CM laterals is making MBs for a hygienist!

Then I was going to compliment the things I like about these current bridges...the opaque-ness at the incisal edge is beautiful and the slight step is just what I wanted. In most lights, the (forgive my ignorance to your trade) "outside color" of the pontic looks awesome..a perfect match! Love those parts.

My only concerns are the "inside color" looking grey. When he remakes them would it be possible to use a different material that looks whiter? (WHAT NOT TO SAY: "Hey I made a bunch of tech buddies online and they said you should have used an LT ingot!"). That's the big question that I'm trying to figure out how to phrase without pushing his buttons! I don't mind describing how I'd like the gingival margins thicker...and I certainly don't mind asking questions about why the wing already popped after a week or so. I am already prepped for two wings, so I'm sure they'll make them with two.

As techs who do this every day, would any of these statements/questions offend you? PLEASE BE HONEST! I would like feedback on how best to communicate my concerns and wants without offending him. How would you want to be spoken to in a situation like this? We have 24 laying hens and I even considered bringing the guy some farm fresh eggs as a bribe! Heck, maybe even bagels for his whole office! The other hygienist I work with said "Just wear something low cut and the guy will do whatever you want!" Ha! She's terrible.

As far as cementing vs bonding...Is rely-x a bonder? They used a curing light for maybe two seconds with whatever they put on. They did NOT etch, I know that, I used to work in ortho.

They are your teeth. Tell the tech your desires and go over the options you have learned about here. You'll be face to face with them so show them
the areas you are not happy with. If you want or think zirconium is your best option, tell them that is what you want. If they are offended the
sun will still come up in the east tomorrow.